Is quality of prison health care in jeopardy?

Because of a lack of medical treatment, Trent Apple claims his multiple sclerosis deteriorated so much he had trouble walking.

Yahteek Miles says his broken wrists went untreated for nearly two months, causing permanent problems with his hands.

And the family of Donald Weiss Jr. alleges he killed himself after mental health experts failed to provide adequate psychiatric care.

Each of these individuals served time at a county prison where a private business provided medical services. And each of them has had a federal civil rights lawsuit filed on his behalf, alleging the business failed to provide sufficient medical care in an effort to save money.

Across the nation, prison health care companies have come under increased scrutiny, with prison watchdogs questioning whether the profit motive has harmed the quality of prison health care. Prisons that have hired private medical companies generally have done so because of the promised financial savings for taxpayers.

"If they're doing it cheaper, it's usually because they're cutting something, and those cuts have consequences for the quality of care," said David Fathi, an attorney with the National Prison Project of the American Civil Liberties Union.

Outside prison, people can shop around for the best health care, limited by the provisions of their health care insurance or the size of their savings accounts. But behind bars, inmates have no choice. When they're sick, they have to use the health care professionals made available to them.

That lack of choice and a 1995 federal law that limits lawsuits by prisoners have provided little reason for the medical firms to raise the quality of their care.

"This sets up all the wrong incentives for the company to cut corners, cut costs, without the fear there will be a lot of consequences for them," Fathi said.

Locally, PrimeCare Medical Inc., based in Harrisburg, provides services at four prisons -- in Lehigh, Northampton, Berks and Monroe counties. Schuylkill County is considering hiring it.

Inmates have filed dozens of suits against PrimeCare, which serves 22 county prisons in Pennsylvania. In Northampton County, at least 16 suits have been filed against the company since it started providing services there in 1999, the most against any local prison served by PrimeCare.

Traditionally a litigious group, inmates often file handwritten suits on a variety of issues that end up being dismissed as frivolous. But in Northampton County, many of the suits against PrimeCare involve prisoners with private attorneys. And many of their cases have been given court approval to move forward.

One of the more significant Northampton County cases involved a seriously ill inmate who reached a $150,000 settlement in 2003 with the county and PrimeCare. It alleged that PrimeCare failed to fill prescriptions and gave incorrect prescriptions and that the prison delayed access to medical care.

Asked why there have been so many suits, Frank Komykoski, PrimeCare's vice president of operations, said: "There's no real rhyme or reason. It's just part of the business."

He noted that the four local jails served by PrimeCare have been accredited by the National Commission on Correctional Health Care, a private organization that sets standards for correctional facilities.

Joshua Lock, PrimeCare's corporate counsel, acknowledged that the number of suits involving Northampton County Prison is higher than in other counties, and said the company tries to correct its mistakes.

"What we don't tout is infallibility," he said. "That would be preposterous for any professional."

In Lehigh County, PrimeCare has a solid record, according to Edward Sweeney, the county's director of corrections. "I think they're very responsive," he said.

PrimeCare has been an improvement over Wexford Health Sources Inc., which provided medical care at the Lehigh County Prison until 2004, Sweeney said. PrimeCare is better partly because it's more oriented toward county jails than Wexford, he said. Inmates have shorter stays in county jails than those in state prisons, so their medical needs are different.

But the owner and president of PrimeCare, Carl A. Hoffman Jr., has a questionable medical record. In 1997, the Pennsylvania Board of Osteopathic Medicine disciplined him. It issued a formal reprimand and fined him $500. At the time, Hoffman owned Pennsylvania Institutional Health Services, the predecessor to PrimeCare, which was contracted to provide medical care at five state prisons.

After an inmate died in the medical unit at Camp Hill state prison, Hoffman altered the inmate's medical records, a hearing examiner for the board concluded. The examiner found that Hoffman had made "misleading, deceptive, untrue or fraudulent entries," impugning his integrity and the integrity of the entire medical profession.